Norepinephrine remains increased in the six-minute walking test after heart transplantation.

OBJECTIVE: We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION: Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS: Twenty heart transplantation (18 men, 49+/-11 years and 8.5+/-3.3 years after transplantation), 11 heart failure (8 men, 43+/-10 years), and 7 healthy subjects (5 men 39+/-8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS: During rest, patients' norepinephrine plasma level (659+/-225 pg/mL) was higher in heart transplant recipients (463+/-167 pg/mL) and healthy subjects (512+/-132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248+/-692 pg/mL) was not different from that of heart failure patients (1174+/-653 pg/mL). Both these groups had a higher level than healthy subjects had (545+/-95 pg/mL), p<0.05. CONCLUSION: Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.

Validation of a cutoff value on echo Doppler analysis to replace right heart catheterization during pulmonary hypertension evaluation in heart transplant candidates.

BACKGROUND: Heart transplantation (OHT) has traditionally been contraindicated in the presence of severe pulmonary hypertension (PH), as detected by right heart catheterization. Noninvasive methods are still not reliably accurate to make this evaluation. OBJECTIVES: Determine the efficacy of echo Doppler analysis for the diagnosis of severe PH. METHODS: One hundred thirty patients (mean age = 42 +/- 15 years, 82 men) showed severe left ventricular dysfunction (mean ejection fraction = 29 +/- 12%; functional class III-IV). We excluded patients with atrial fibrillation, heart failure secondary to congenital disease, and valvulopathy. The pulmonary parameters defined as severe PH were: systolic pulmonary artery pressure (sPAP) >or= 60 mm Hg; a mean transpulmonary gradient >or= 15; or pulmonary vascular resistance >or= 5 Wood units. Patients underwent a right heart catheterization using a Swan-Ganz catheter to measure hemodynamic parameters and to noninvasively estimate right-sided pressures from spectral Doppler recordings of tricuspid regurgitation velocity (right ventricular systolic pressure [RVsP]). A Pearson correlation of sPAP was obtained with RVsP by; the sensitivity of RVsP for the diagnosis of PH was determined by a receiver operating characteristic (ROC) curve. RESULTS: A good correlation between sPAP and RVsP was obtained by Pearson correlation analysis (r = 0.64; 95% confidence interval [CI] 0.50-0.75; P < .001). The ROC curve analysis showed a sensitivity of 100%, a specificity of 37.2%, (95% CI 0.69-0.83, P < .0001) of a RVsP < 45 mm Hg (cutoff) on the exclusion of severe PH. CONCLUSIONS: The cutoff of RVsP < 45 mm Hg, on noninvasive echo Doppler evaluation of PH is an efficient method to replace invasive heart catheterization in OHT candidates.

Dobutamine stress echocardiography in heart transplant recipients' evaluation: the role of reinnervation.

INTRODUCTION: Orthotopic heart transplantation renders the recipient denervated. This remodeling of the intrinsic cardiac nervous system should be taken in account during functional evaluation for allograft coronary artery disease. Dobutamine stress echocardiography (DSE) has been used to detect patients at greater risk. The aim of this study was to determine whether patients with various autonomic response levels, and supposed reinnervation patterns, show the same response to DSE. METHODS: We studied 20 patients who had survived more than 5 years after orthotopic heart transplantation. All patients underwent a Holter evaluation. We considered patients with low variability to be those with less than a 40-bpm variation from the lowest to highest heart rate, so-called "noninnenervated" (group NI). Patients who had 40-bpm or more variation were considered to show high variability and called "reinnervated" (group RI). After that, all patients performed an ergometric test and DSE. RESULTS: Groups were defined as NI (n = 9) and RI (n = 11). Ergometric tests confirmed this response with NI patients showing less variability when compared to RI patients (P = .0401). During DSE, patients showed similar median heart rate responses according to the dobutamine dose. Spearmen correlation showed r = 1.0 (P = .016). CONCLUSIONS: DES was effective to reach higher heart rates, probably related to catecholamine infusion. These findings may justify a better response when evaluating cardiac allograft vasculopathy in heart transplant patients.

Recovery of renal function in heart transplantation patients after conversion from a calcineurin inhibitor-based therapy to sirolimus.

BACKGROUND: Renal failure is the most important comorbidity in patients with heart transplantation, it is associated with increased mortality. The major cause of renal dysfunction is the toxic effects of calcineurin inhibitors (CNI). Sirolimus, a proliferation signal inhibitor, is an imunossupressant recently introduced in cardiac transplantation. Its nonnephrotoxic properties make it an attractive immunosuppressive agent for patients with renal dysfunction. In this study, we evaluated the improvement in renal function after switching the CNI to sirolimus among patients with new-onset kidney dysfunction after heart transplantation. METHODS: The study included orthotopic cardiac transplant (OHT) patients who required discontinuation of CNI due to worsening renal function (creatinine clearance < 50 mL/min). We excluded subjects who had another indication for initiation of sirolimus, that is, rejection, malignancy, or allograft vasculopathy. The patients were followed for 6 months. The creatinine clearance (CrCl) was estimated according to the Cockcroft-Gault equation using the baseline weight and the serum creatinine at the time of introduction of sirolimus and 6 months there after. Nine patients were included, 7 (78%) were males and the overall mean age was 60.1 +/- 12.3 years and time since transplantation 8.7 +/- 6.1 years. The allograft was beyond 1 year in all patients. There was a significant improvement in the serum creatinine (2.98 +/- 0.9 to 1.69 +/- 0.5 mg/dL, P = .01) and CrCl (24.9 +/- 6.5 to 45.7 +/- 17.2 mL/min, P = .005) at 6 months follow-up. CONCLUSION: The replacement of CNI by sirolimus for imunosuppressive therapy for patients with renal failure after OHT was associated with a significant improvement in renal function after 6 months.

Results of heart transplantation: 16 years' experience in a center in Argentina.

UNLABELLED: Heart transplantation (HTx) is the treatment of choice for advanced heart failure refractory to other treatments. OBJECTIVE: To report the outcomes of patients undergoing orthotopic HTx in a center with 16 years' experience. METHODS: We retrospectively examined the outcomes from three hundred nine HTx recipients between February 1993 and March 2009. The mean recipient age was 46 +/- 16 years, and 80% were male. Ischemic cardiomyopathy was present in 37%; 43% (n = 133) were elective procedures and 57% (n = 176) were urgent/emergency procedures. The mean donor age was 26 years; their main cause of death was head/brain trauma. Survival was studied using Kaplan-Meier curves. RESULTS: The global survival rates at 1, 5, 10, and 15 years were 80%, 74%, 71%, and 65%, respectively. Excluding losses during the first year after transplantation (conditional survival), the survival rate at 5 and 10 years reached 92% and 88.5%, respectively. The median follow-up was 7.7 years. The etiology and the urgent/emergency nature of the procedures did not show significant differences regarding the mortality rate (P = .8). The main causes of death were sepsis (28%) and primary nonfunction (18%). In-hospital mortality reached 16%. No significant differences were observed between the urgent/emergency versus the elective transplant procedures (P = .06). During the follow-up, the incidence of severe acute cellular rejection episodes was <3% after 5 years. The global incidence of antibody-mediated rejection reached 4.5%. Eleven subjects (3.5%) were diagnosed with post-transplantation lymphoproliferative disorder. During long-term follow-up, the incidences of kidney failure, diabetes mellitus, hypertension, and dyslipemia were 21%, 24%, 69%, and 70%, respectively. One percent required chronic dialysis. CONCLUSION: In our center, post-HTx survival rates at 1, 5, 10, and 15 years were 80%, 74%, 71%, and 65%, respectively, which were similar to those reported by the International Society of Heart and Lung Transplantation (ISHLT).

Norepinephrine remains increased in the six-minute walking test after heart transplantation

OBJECTIVE: We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION: Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS: Twenty heart transplantation (18 men, 49±11 years and 8.5±3.3 years after transplantation), 11 heart failure (8 men, 43±10 years), and 7 healthy subjects (5 men 39±8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS: During rest, patients' norepinephrine plasma level (659±225 pg/mL) was higher in heart transplant recipients (463±167 pg/mL) and heathy subjects (512±132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248±692 pg/mL) was not different from that of heart failure patients (1174±653 pg/mL). Both these groups had a higher level than healthy subjects had (545±95 pg/mL), p<0.05. CONCLUSION: Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.

Trasplante cardiaco / Cardiac transplant

La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R.A. Calderón Guardia inició hace un año un Programa de Trasplante Cardíaco, presentamos aquí los 2 primeros pacientes y su seguimiento.

Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara.

BACKGROUND: Weight changes frequently occur after cardiac transplantation (CT) and increase the risk of secondary diseases. OBJECTIVE: To determine the impact of weight variation on serum levels of glucose, triglyceride, total cholesterol, LDL, HDL and triglycerides of cardiac transplant patients. METHODS: Retrospective documentary study conducted with 82 adult patients undergoing CT between October 1997 and December 2005 in the State of Ceara, Brazil. A total of 83% of the patients were male and the mean age was 45.06+/-12.04 years. The variables studied were biopathological profile, weight, and body mass index (BMI) in relation to biochemical and metabolic changes. Data were described using frequencies, measures of central tendency, Student's t test and Pearson's correlation coefficient. RESULTS: The mean overall BMI increased from 23.77+/-3.68 kg/m2 prior to CT, to 25.48+/-3.92 kg/m2 in the first year and to 28.38+/-4.97 kg/m2 in the fifth. Overweight/obese patients (BMI > or = 25 kg/m2) showed mean values of glucose, total cholesterol, low-density lipoprotein (LDL) and triglycerides higher than those of normal-weight/underweight patients (BMI < 25 kg/m2). CONCLUSION: There was a significant direct relation between nutritional state and weight variability on the metabolic profile of cardiac transplant patients.

Impacto da variabilidade de peso na estabilidade metabólica dos pacientes transplantados cardíacos no Ceará / Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara

FUNDAMENTO: As alterações de peso após o transplante cardíaco (TC) freqüentemente ocorrem e aumentam os riscos de doenças secundárias. OBJETIVO: Determinar o impacto da variabilidade do peso nos níveis séricos de glicose, triglicérides, colesterol total e frações dos pacientes transplantados cardíacos. MÉTODOS: Estudo retrospectivo documental realizado com 82 pacientes adultos submetidos a TC entre outubro de 1997 e dezembro de 2005 no Ceará, sendo 83 por cento do sexo masculino e a idade média de 45,06±12,04 anos. As variáveis estudadas foram o perfil biopatológico, o peso e o índice de massa corporal (IMC) relacionadas às alterações bioquímico-metabólicas. Os dados foram descritos usando freqüências, medidas de tendência central, teste t de Student e coeficiente de correlação de Pearson. RESULTADOS: A média global do IMC aumentou de 23,77±3,68kg/m² antes do TC, para 25,48±3,92kg/m² no primeiro ano e para 28,38±4,97kg/m² no quinto. Os pacientes com sobrepeso/obesidade (IMC > 25 kg/m²) apresentaram valores médios de glicose, colesterol total, lipoproteína de baixa densidade (LDL) e triglicérides maiores que os pacientes com eutrofia/desnutrição (IMC < 25 kg/m²). CONCLUSÃO: Houve uma relação direta e significativa entre o estado nutricional e a variabilidade de peso no perfil metabólico de pacientes transplantados cardíacos.

BACKGROUND: Weight alterations post cardiac transplant (CT) frequently occur and increase the risks of secondary diseases. OBJECTIVE: This study aimed at determining the impact of weight variability on serum levels of glucose, triglycerides, total cholesterol and its fractions of cardiac transplant patients. METHODS: This was a retrospective documental study held with 82 patients submitted to CT between October, 1997 and December, 2005 in Ceará, Brazil. 83 percent were male and the average age was 45.06±12.04 years. The studied variables were: biopathology profile, the weight and the body mass index (BMI) related to the biochemical-metabolic alterations and to the survival. Data were described using frequencies, measures of central tendency, t-Student test and Pearson correlation coefficient. RESULTS: The average global BMI increased from 23.77±3.68kg/m² before CT to 25.48±3.92kg/m² on the first year and to 28.38±4.97kg/m² on the fifth year. The patients with overweight/ obesity (IMC > 25 kg/m²) presented average glucose mean levels, total cholesterol, low-density lipoprotein (LDL) and triglycerides higher than the patients with eutrophy/ malnutrition (IMC < 25 kg/m²). CONCLUSION: There was a significant direct relation between nutritional state and weight variability on the metabolic profile of cardiac transplant patients.

Decreased exercise performance with age in children with hypoplastic left heart syndrome.

OBJECTIVE: Children born with hypoplastic left heart syndrome (HLHS) may experience cardiac dysfunction after staged surgery or transplantation, which may worsen with age. We examined the hypothesis that exercise testing can address cardiovascular capacity and suggest interventions to improve quality of life. STUDY DESIGN: Children with HLHS > or = 8 years old performed treadmill or bicycle ergometric testing at 4 centers. Results were compared with norms for age and sex. RESULTS: Of the 42 participants, the mean age was 12.9 years (range, 8.5-17.0 years), 64% were boys, 20 had staged surgery, and 34 completed metabolic assessment. The percent of predicted maximal oxygen uptake (mVO2) was higher in younger children. Children aged 8 to 12 years achieved 70% of predicted mVO2; children aged 13 to 17 years achieved 60% of predicted mVO2 (P = .02). The percent of predicted peak heart rate trended higher in younger patients (83% versus 75%, P = .07). Electrocardiographic changes were more common in older children. In treadmill testing, patients who had a transplant had better exercise performance than patients who underwent staged surgery in percent of predicted exercise time (82% versus 54%, P < .0001) and peak rate-pressure product (241 x 10(3) versus 195 x 10(3), P = .02). The percent of predicted mVO2 did not differ between patients who had a transplant (66%) and patients who underwent staged surgery (61%, P = .25). CONCLUSION: Children with HLHS showed considerable age-related decline in exercise performance, regardless of surgical strategy.

Acute effects of a single dose of phosphodiesterase type 5 inhibitor (sildenafil) on systemic arterial blood pressure during exercise and 24-hour ambulatory blood pressure monitoring in heart transplant recipients.

BACKGROUND: Arterial systemic hypertension (SH) can be associated with a decrease in endothelium-dependent nitric oxide (NO). Sildenafil increases cyclic guanosine monophosphate (cGMP), a mediator of NO. However, little is known about the effects of PDE5 inhibition on 24-hour ambulatory pressure (ABP) and exercise blood pressure, noreprinephrine (Nor), and exercise capacity, especially after orthotopic heart transplantation (OHT). METHODS: We studied 22 OHT patients who on the 1st day underwent a cardiopulmonary (CP) self-controlled treadmill 6' walk test (6') and, then, an ECG monitored CP treadmill maximal exercise test (Ex) within 60 and 90 minutes after oral Sildenafil (Sil; 50 mg) or placebo (Pl) given at random, and ABP. We determined at basal position (b), in the last minute of the 6' and at the peak Ex, the HR (bpm), Systolic blood pressure (SBP), and diastolic blood pressure (DBP), (mm Hg), VO2 (mL/kg/min), Slope VE/VCO2, exercise time (ET, min), distance (D; miles), and Nor (pg/mL). Also, after CP tests, 24-h SBP and DBP, the measurements were repeated on the 2nd day when the cross-over was done. RESULTS: Sil significantly reduced blood pressure in the basal position and during exercise. It also promoted a significant reduction in SBP and DBP during 24 hours, daytime and nighttime. Sil did not change exercise capacity. CONCLUSION: The NO-cGMP pathway seems to play a role in blood pressure control in OHT. In addition to antihypertensive therapy, PDE5 inhibition may have potential beneficial effects on hypertensive OHT.

A elevação da pressão arterial sistólica durante o teste ergométrico após transplante cardíaco: correlação com o quadro clínico e a função ventricular avaliada pela ecocardiografia sob estresse com dobutamina / Increase in systolic blood pressure during exercise testing after heart transplantation: correlation with the clinical condition and ventricular function assessed by dobutamine stress echocardiography

OBJETIVO: Em pacientes submetidos a transplante cardíaco (TxC) descreve-se redução da elevação da pressão arterial durante o teste ergométrico (TE). Este fenômeno, cuja origem é desconhecida, ocorre em freqüência e intensidade variáveis. O objetivo deste estudo foi verificar a relação entre o incremento da pressão arterial sistólica (deltaPAS) e aspectos clínicos, bem como as variáveis aferidas no TE e ecocardiograma sob estresse pela dobutamina (EED), em pacientes na fase tardia após TxC. MÉTODOS: Quarenta e cinco homens, 49,04±10,19 anos, 40,91±27,46 meses pós-TxC submeteram-se a avaliação clínica, TE e EED . Avaliou-se o índice de contratilidade segmentar e a fração de ejeção de ventrículo esquerdo. Consideraram-se anormais deltaPAS<35mmHg no TE (SBC,1995). RESULTADOS: Não houve correlação significativa entre deltaPAS e o tempo de evolução do transplante, tempo de isquemia do enxerto, antecedentes de rejeição, dose de diltiazem, consumo de oxigênio estimado, fração de ejeção e índice de contratilidade segmentar. O deltaPAS foi normal em 17 casos (Grupo I) e anormal em 28 pacientes (Grupo II). Não houve diferenças significativas entre os pacientes de ambos os grupos em relação aos aspectos clínicos e aos resultados do TE e EED. CONCLUSÃO: Ao contrário de outras populações, os autores não detectaram correlações entre deltaPAS e o quadro clínico e a função ventricular esquerda em pacientes com TxC. Os fatores associados à redução do deltaPAS no TE pós-TxC permanecem desconhecidos.

OBJECTIVE: Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressure increase (delta SBP) and clinical aspects, as well as variables measured during exercise testing (ET) and dobutamine stress echocardiography (DSE) in patients in the late post-transplantation course. METHODS: Forty-five men, mean age 49.04 ± 10.19, underwent clinical assessment, ET and DSE 40.91 ± 27.46 months after heart transplantation. Left ventricular wall motion score index and ejection fraction were assessed. Delta SBP < 35mmHg during ET was considered abnormal (SBC,1995). RESULTS: No significant correlation was found between delta SBP and post-transplantation time, graft ischemic time, history of rejection, diltiazem dosage, oxygen uptake, ejection fraction, and wall motion score index (WMSI). Delta SBP was normal in 17 patients (Group I) and abnormal in 28 (Group II). Patients of both groups did not differ significantly in regard to clinical features and ET and DSE results. CONCLUSION: Unlike other populations, no correlation was found between delta SBP during exercise testing and clinical condition or left ventricular function in heart transplant patients. Pathophysiological factors associated with delta SBP reduction during exercise testing remain unknown.

Increase in systolic blood pressure during exercise testing after heart transplantation: correlation with the clinical condition and ventricular function assessed by dobutamine stress echocardiography.

OBJECTIVE: Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressure increase (delta SBP) and clinical aspects, as well as variables measured during exercise testing (ET) and dobutamine stress echocardiography (DSE) in patients in the late post-transplantation course. METHODS: Forty-five men, mean age 49.04 +/- 10.19, underwent clinical assessment, ET and DSE 40.91 +/- 27.46 months after heart transplantation. Left ventricular wall motion score index and ejection fraction were assessed. Delta SBP < 35 mmHg during ET was considered abnormal (SBC,1995). RESULTS: No significant correlation was found between delta SBP and post-transplantation time, graft ischemic time, history of rejection, diltiazem dosage, oxygen uptake, ejection fraction, and wall motion score index (WMSI). Delta SBP was normal in 17 patients (Group I) and abnormal in 28 (Group II). Patients of both groups did not differ significantly in regard to clinical features and ET and DSE results. CONCLUSION: Unlike other populations, no correlation was found between delta SBP during exercise testing and clinical condition or left ventricular function in heart transplant patients. Pathophysiological factors associated with delta SBP reduction during exercise testing remain unknown.

Later evolution after cardiac transplantation in Chagas' disease.

OBJECTIVE: This research reported the accumulated experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality. METHODS: Fifty-nine patients undergoing cardiac transplantation had Chagas' disease with classically accepted recipient selection criteria. In this series, 84.7% of the patients were functional class IV; 36.0% used vasopressor support; and 13.5% mechanical circulatory assistance. One patient received a heart and kidney transplantation. RESULTS: After the initial experience the doses of immunosuppressants were significantly reduced with improvement in outcomes. The diagnosis of the reactivation of disease was documented by the identification of parasite in the myocardium, or on subcutaneous or serological exams. Reactivation of disease was significantly reduced by decreasing the immunosuppression. Immediate mortality occurred in 10 cases: three infections, two allograft dysfunction, two rejections, and two sudden deaths. Subsequent mortality happened in 14 patients: four by lymphoma, three by infection, two by Kaposi's sarcoma two by rejection, two by constrictive pericarditis, and one by reactivation of disease in the brain. CONCLUSIONS: There's no correlation between the disease and pre- or postoperative prophylaxis. The early diagnosis and specific treatment of reactivation did not leave functional sequelae in the myocardium. Reduction in immunosuppression significantly reduced reactivation of disease and neoplasms. The combined transplantation can be realized safely with more care about the immunosuppressants.

Reabilitacão física no transplante de coracão / Physical rehabilitation in heart transplantation

Após o transplante cardíaco os pacientes melhoram a qualidade de vida. Porém, freqüentemente apresentam problemas clínicos pós-operatórios, como descondicionamento físico, atrofia e fraqueza muscular e menor capacidade aeróbia máxima, decorrentes em parte da inatividade pré-operatória e de fatores como diferenca de superfície corpórea doador/receptor, denervacão do coracão, entre outros. A atividade física regular tem papel importante na terapêutica dos transplantados, devendo ser iniciada precocemente, se possível ainda na fase hospitalar, dando prosseguimento pós-alta hospitalar, para que possam retornar a um estilo de vida normal, próximo do que tinham antes da doenca, permitindo um convívio social satisfatório, com retorno a uma vida ativa e produtiva.

Alterações no consumo de oxigenio, na difusão da membrana alveolo-capilar e anormalidades musculo esqueleticas observadas apos transplante cardiaco / Impairement in oxygen uptake on alveolar-capillary membrane diffusion and musculoskeletal abnormalities after heart transplantation

Observar as anormalidades persistentes apos transplante cardiaco e a influencia destas na capacidade para o exercicio. Foi realizada revisao da literatura nos ultimos 13 anos atraves dos bancos de dados Medline, Lilacs e livros puiblicados no periodo. Ainda que, apos a intervençao cirurgica, haja um incremento na performance cardiaca, nos sintomas e na hemodinamica, as alteraçoes no consumo de oxigenio, na difusao da membrana alveolo-capilar e anormalidades musculoesqueleticas persistem apos o transplante cardiaco, apesar da discreta melhora. Anormalidades musculoesqueleticas, na difusao da menbrana alveolo capilar e no consumo de oxigenio adquiridas no curso da insuficiencia cardiaca congestiva, nao sao curadas apos transplante cardiaco. Esses resultados interferem diretamente na capacidade para o exercicio desses pacientes.